Background to this inspection
Updated
3 June 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 20 April 2017 and was unannounced. It was carried out by two inspectors.
The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information we held about the service. We looked at notifications received by CQC. A notification is information about important events which the provider is required to tell us about by law, like a death or serious injury.
We looked around areas of the service, and talked to five people who live at the service. Conversations with people took place in people’s rooms and the main communal areas. We did not use the Short Observational Framework for Inspection (SOFI) as people were able to talk with us. SOFI is a way of observing care to help us understand the experience of people who could not talk to us.
We reviewed records including four care plans and risk assessments. We looked at a range of other records, staff rotas, medicine records and quality assurance surveys and audits.
We talked with relatives who were visiting people, the registered manager, care staff, the cooks, domestic staff and the finance assistance. We spoke with health care professionals before the inspection.
The previous inspection was carried out in September 2015, no breaches of regulations were identified at this inspection.
Updated
3 June 2017
This inspection was carried out on the 20 April 2017 and was unannounced.
St Albans House provides accommodation for up to 19 older people who need support with their personal care. The service is converted house. Accommodation is arranged over three floors. A stair lift and a passenger lift are available to assist people to access the upper floors. The service has 19 single rooms including two with en-suite facilities. There were 14 people living at the service at the time of our inspection.
The registered provider, Deal Old People’s Housing Society Limited is a registered charity and a committee oversees the running of the service. A registered manager was working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
People told us that they felt safe living at St Alban’s. However, detailed information was not available for staff to refer to about how to manage risks to people. This did not impact on people as staff knew how to keep people as safe as possible. Accidents and incidents had been recorded, these had not been analysed to identify any patterns or trends to prevent them happening again.
People received their medicines when they needed them, but medicines were not always recorded and managed safely.
There was not always sufficient staff on duty to provide care and support to people when they needed it. Care plans did not contain detailed information about people’s choices and preferences. Staff knew people well and supported them in a person centred way.
The provider had a recruitment process in place to make sure that staff employed were of good character. This process had not been followed consistently and shortfalls were identified at the inspection. Staff had completed training to be able to provide safe and effective care, however, this training needed to be updated.
Staff received one to one supervision and yearly appraisals to identify their development and training needs. Staff told us that they did not always feel supported or listened to by the registered manager, and some of their concerns had not been addressed. The culture within the service was not open, inclusive and empowering. The registered manager and the staff were not working together as a team. Staff felt that the service had lost its vision about the care provided.
Checks on the environment and appliances such as the lift and boiler had been completed to keep people safe. There were systems in place to monitor the quality of the service. Surveys had been sent to relatives, staff and other stakeholders such as district nurses but not to people. Audits had been completed but not identified the shortfalls found within the service.
The registered manager had not formally assessed people’s capacity to make specific decisions. When speaking with people they had capacity and staff supported them to make decisions. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under MCA. The application procedure for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). People were not restricted and there were no authorisations in place.
People’s health was monitored and staff worked with health and social care professionals to make sure people’s health care needs were met. People were offered a balanced diet and were offered food they liked. People had the opportunity to join in activities; people told us that staff supported them to continue their hobbies and interests.
Staff were kind and caring to people and treated them with dignity and respect. Relatives and friends were encouraged to visit people. Staff knew visitors and people well; there was a warm and friendly relationship. Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager.
There were procedures in place to record and investigate complaints, there had been no complaints recorded. The provider had submitted notifications to the Care Quality Commission in a timely manner and in line with guidelines.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made recommendations. You can see what actions we have asked the provider to take at the end of this report.